Outdoor workers are at increased risk for skin cancer because of occupational exposure to ultraviolet radiation in sunlight. Our research team has developed Go Sun Smart (GSS), an occupational sun protection program for outdoor workers, and demonstrated its effectiveness. We also evaluated successful theory-based strategies for disseminating GSS to the entire North American ski industry. The proposed study is designed to examine the sustainability of GSS dissemination and provide a final assessment in a comprehensive decade-long examination of the development, effectiveness, dissemination, and sustainability of a workplace sun protection program. Sustainability of health intervention programs is essential to achieve long-term health behavior change;however, only limited research exists on the sustainability of evidence-based prevention programs. Sustainability of GSS will be assessed by observing continued use of GSS at the ski areas that participated in the GSS II dissemination trial. Specific aims of the sustainability assessment are to 1) evaluate the continued use of GSS by the workplaces enrolled in the GSS II dissemination trial;2) examine whether continued use of GSS was affect by dissemination strategy (Basic v. Enhanced);3) explore continued theoretical fidelity of the occupational sun protection principles in GSS;and 4) determine whether sustained use of GSS, if present, influences employees'sun protection. We expect that 61 of the original 68 ski areas in the GSS II dissemination trial will agree to participate in this 2-year project on GSS sustainability. Trained research staff will return to each ski area and observe use of GSS and non-GSS messages and actions intended to improve occupational sun safety. We will use the on-site observations, a modified version of the survey of managers from the GSS II dissemination trial, and a new pilot-tested protocol for performing semi-structured interviews with senior managers to measure continued use of GSS, theoretical fidelity of occupational sun protection principles, and the integration of GSS and sun protection into organizational culture at the ski areas. Intercept surveys with employees using a shortened version of the employee survey from the GSS II dissemination trial will be conducted to assess continued influence of GSS on employees'sun safety (i.e., exposure to sun safety messages, reduced prevalence of sunburn, and increased frequency of sun protection practices). The proposed project is significant and innovative because it will a) help to fill a gap in the understanding of the sustainability of prevention programs in general and occupational sun protection in particular;b) explore whether strategies used to disseminate a program affects its sustainability;c) identify organizational characteristics that affect program sustainability;d) determine whether workplaces implement changes that promote occupational sun protection principles even if they do not utilize GSS;and e) test whether GSS continues to improve sun safety by employees. PUBLIC HEALTH RELEVANCE: Outdoor workers are at increased risk for skin cancer and our team developed an effective occupational sun protection program, Go Sun Smart. In a previous study, strategies for disseminating this program to the entire North American ski industry were evaluated and researchers will return to the workplaces participating in that study and perform a final assessment of whether they continue to use Go Sun Smart. Sustainability of prevention programs is a major concern for public health because sustained intervention is essential to achieve long-term improvements in health.